02040027 i .-CITYBUILDING c DPEeioNNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10303 DEGAS CT WOODS ROOFING 02040027
OWNER'S NAME: APPLICATION SUB DATE
H. KALLA 1020 HICKORY CT 04/05/2002
PHONE: (831) 637—5576 SANITARY NO. CONTROL NO.
m00 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
<ii U CJ L J
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zv- lhcmbyaffinohmIwo liccnsedunderrprmiNami.fChaper9(commencing Job Description
' ATION
„�a°, wimsenion]O(q) roll on3ofIse minessandp�+re.,ion e.,,pmyBanx REROOF
is in full I(
force j
ia�r�< uanx etas . Lieu 3 T/O SHA-
KES, RESHEET 2/16" OSB
O
no.UDa¢_( Cwunrw +r
?LLQti ARCHITECr'SDECLARA ON ADD 50 YR. ELK COMP. SHINGLES .
g
r 1 understand my plans shall Ise used as public record.
Licensee Pmlessional
a
OWNER-BUILDER DECLARATION
on 1 hereby affirm rhe 1 I. caempi from the ftesaacmr's License Law for me
2?0 whiching rmss star cion](IJLS. t,alter,imp Professions h,or ra ny city or county
Y F es pooch requires n pemsr re comwe�,ppha improve,demolish,ore a sig any swemre
i 3 poor t issuance. I q m ppl<ant(r uchpea 11 asg W tammem
mcmor els gn-d'my Sen na7").f
el fDivision 3 oftm Business: and Professors Sq. FC F1oorArea,, k r r $128Uuation
or Sect he a exempt a ref o li and the Permit
fns me subjects
esemprn to Any violation ' ' '
-of Section]W L5 by any applicant for o pnit subjcs She,pplicam to a civil penalty A P�pi
Iofnotmoremanfivehandleddollars($50fif3423UU b ... 1. Occupancy'lype
❑1,do
owner of She property,ser my emplo t in wide wages as ed f sole c (See.Tion,
will do'me'work:'and the arunurt is not intertest or offered for sale(Sec.]p,6,"
Business and Professions Code:The Commerce's License Law does nor apply m an 305 — FRAME Required Inspections " -•
owner of property Who builds or improves thereon,and who does such work himself
or mroogh his own employees.provided that suchmpr improvements are had intended year or _ __ 307 — INSULATION
vlo6offered f le If mu rfi bidding e improvement soldwithinone Ywr of - - OFF
comp(ion,rhe apncr bdlenwll have Shch Ivo or proving[bathe did not build or 601 — ROOF TEAR OFF -
impravefor
puryoseofsled. 602 — ROOF
- = Professions
- PLYWOOD
N
AIL
I,s owner of the p ops am spellssclYcontracting wth licensed contra — 'ROOF BATT $canwcd the pmjen(Sec ] W,Bus nesseand Profec ons Code)The Cammcor's 603
n
""- License Law does nor apply toanowner ofpropenywho builds orimprovesthereon, 604 — ROOF IN—PROGRESS
;. _and who.condons.for.such Foci with a.com ucmess).licerad.punuam dome .. _.. .._... ...... .. .. . . ......__
Cmmmtiars License law. --
❑I am eaempd under Sec: ,B&P C tenets reason
owner Dade
WORKER'S COMPENSATION DECLARATION
"' 1M1ertby aRrm under pcwhy of perjury one ofrhe following dcdannions: FINALED
° 1 have and will maintain a Certificate of Conxm ro self-imme for Worker's
3 Compensation, as provided 1'or by Section 3708 of the Labor Code, for the APR 1 8 2002
pMm
oance of the work farmit r which this peis issued.
16I h d 'll maim w k s Comps . d o Insurance,
required by Sweden p
] f rh Lebo Code f do pen'rte,ce of er -work i which his pcmi S hs -----
WORKERS', -. .BUI LDIING _..� ...
issued.My Worker s Comp)c i Insurance c daPol ty number are:
J h .CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE . .._ ----------__._.___.....______.__.______..___.._�..__.....-._.
(Thos section need not be cnmptncd if the permit is for one hundred dollars
(5IW)ar less) - '
.. .I .. :-. ..._._ _
I<¢fyman me pert fm wk for which'his pe the issucdl - ":, "'..•' . . .._•.'..•,
not
Compensationemploy
Laws o C lifamha.Daienn' as m become subject d the Workers' k '
..Applicata ., .. .. ..
NOTICE TO APPLICANT If, 0 neking'his Cen team of Exem tion,tauanau
_ -" '-'"--'-----
v h
&come subjen mmcW ke Compensad p .of the Labor you must
zO O fo'rthw ih comply w dh e p ar rh' p rm t hall be im metl rtvaked
� ._ _ .. . . . . .. . __ _ ._.
-"CONSTRUCTION LENDING AGENCY
a. 7 1 h by affirm that the cosi et lending agency for the performance -
bfm - kfr hichm p2rm d'. slued(S JW]Civ.C) - '
O,Z Inde Addmss •, _ I _ ..
Q�c
. 1 ismilyagree
Som I have mita this app(c t o and state mats above haws relating g
_U coma.1 egos tr comply wird all city and county ordinances and same lawn enter
upon
OW teholding
e-mentioned propenand cereinspectioneuprcsenwdives 6f this mcmerupon
A. Ne,bovWe)ilionW pmpendemify and
purposes.
A. (We)hgrtcrosave,indemnify c.peons whihamayinthewayarive aiainst laid
Z) liabilities,politicians.ismireami oil upenxs which may in any way seems against said
U Z City in co a UND R the g' t ng of his permit `
'APPLICANI'UTDERSTAND - ' WILL COlvlPLX WITH A1.1,N0P 1
SOURCE REGULATIONS, O - � Issued by: Date
Signature of APMn'anUcomrac or
H
. fsAZARDOUS MATERIALS DISCOSURE Low" Re-rOO
ilmorocafp/ goePsterecus al an e ( Typeof Roof.
f. - 9... . .:.... Y-as definedbYmCupertino Municipal Chapterland me Health and Safc,rycone sen nzssJ (.)
All roofs shall be inspected prior to any roofing material being ins
0 Y pyo- _ , n y
tolled.
W II me 1 r fm bu Id'n .. ._
t, e p use cqu p t a v ccse men If a roof is installed without first obtainin an ins ectiori; I'agree'to remove
A Quality g p
Difdr ' all new materials for inspection. Applicata understands and will comply with
'a.n ,:era contaminants as aernWgm ByA
° es
Y �� or all non-point source regulations;
LS.f1,jCvd1,
d-mc oscut cuyCWea Sa ns tenan50Jt itis nd2553a1 d mtMShat etc hly h' eaten Smr'i' iY-spo 611 d thymeequirecu d h hcues bemdp oI... sofa Cf
Signa _ Applic Date
Lure of aAll roof coverings to be Class"B" or better
cd agent Ume
. . ..OFFICE- "